摘要
目的：探讨经会阴四维超声在诊断女性膀胱膨出中的应用价值。方法：应用经会阴四维超声，以40例正常经产妇作为对照，分别在正中矢状面和三维重建面观察40例膀胱膨出患者在静息和张力两种状态下膀胱尿道及盆膈裂孔的变化，测量相关参数并对膀胱膨出组进行Green分型。结果：正中矢状切面：静息期，膀胱膨出组膀胱颈至耻骨联合后下缘的垂直距离与对照组比较，差异无统计学意义（P＞0.05），但膀胱尿道后角大于对照组（P＜0.05）。张力期，膀胱膨出组膀胱颈至耻骨联合后下缘的垂直距离由负值变为正值，而对照组仅为负值的减少。膀胱膨出组的膀胱颈移动度、膀胱尿道后角和尿道旋转角较对照组均明显增大（P＜0.05）。膀胱膨出组Green分型：Ⅰ型4例、Ⅱ型24例、Ⅲ型12例。三维重建面：静息期，膀胱膨出组盆膈裂孔左右径、前后径、面积、周长均较对照组偏大（P＜0.05），但耻骨内脏肌角度比较差异无统计学意义（P＞0.05）。张力期，膀胱膨出组上述测值均较对照组明显增大（P＜0.05）。膀胱膨出组缩肛状态下TUI模式显示耻骨直肠肌未见明显撕裂，肛提肌尿道间隙两侧对称，距离均小于25 mm。结论：经会阴四维超声可动态观察膀胱膨出，对其诊断、分型及评估盆底解剖和功能都有重要的价值和意义，值得临床推广应用。
Abstract
Objective: To investigate the application value of transperineal four-dimensional(4D) ultrasound in female patients with bladder prolapse． Methods: Transperineal 4D ultrasound was performed in 40 cases of normal puerpera and 40 cases of female patients with bladder prolapse. In condition of resting and tension, the real-time movement of pelvic organ was investigated and the relevant parameters of bladder urethral and levator hiatus were measured in median sagital plane and three-dimensional(3D) reconstruct plane. Different types of bladder prolapse were diagnosed according to Green. Results: In median sagital plane, there was no significant difference in the horizontal distence of bladder neck to symphysis pubis between bladder prolapse group and control group(P＞0.05) in rest period, but the angles of retrovesical were larger in bladder prolapse group than in control group(P＜0.05). In tension period, the horizontal distances of bladder neck to symphysis pubis were changed from negative to positive in bladder prolapse group. But the negative were only decreased in control group, the bladder neck movement degrees, retrovesical angles, urethral rotation angles were significantly larger in bladder prolapse group than those in control group(P＜0.05). There were 4 cases typeⅠ, 24 cases type Ⅱ and 12 cases type Ⅲ by Green in bladder prolapse group. In 3D reconstruct plane, the hiatus’ left-right diameter, anteroposterior diameter, circumference and area were measured and determined, all of which were larger in bladder prolapse group than in control group(P＜0.05), but there was no significant difference in the angle of puborectalis between bladder prolapse group and control group(P＞0.05). In tension period, all the indicators of bladder prolapse group were increased significantly compared with the control group(P＜0.05). In prolapse group, puborectalis was not avulsion, the levator-uretha gaps were zygomorphy and the gaps were all less than 25 mm with tomographic ultrasound imaging(TUI) in constraction period. Conclusions: The transperineal 4D ultrasound can be used to dynamic observe bladder prolapse, distinguish different types of bladder prolapse and evaluate the pelvic floor anatomy and function of bladder prolapse, which is worthy of clinical popularization and application．
关键词
膀胱疾病 /
超声检查
Key words
Bladder diseases /
Ultrasonography
杨 莉;钱胜利;李 延;张 俊;乔 伟;孟 芬.
经会阴四维超声在诊断女性膀胱膨出中的初步应用[J]. 中国临床医学影像杂志. 2015, 26(8): 585-588
YANG Li;QIAN Sheng-li;LI Yan;ZHANG Jun;QIAO Wei;MENG Fen.
Preliminary study of the diagnosis value in female bladder prolapse by transperineai four-dimensional ultrasound[J]. Journal of China Clinic Medical Imaging. 2015, 26(8): 585-588
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